Provider Demographics
NPI:1740275155
Name:VEMPATI, ANURADHA (MD)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:VEMPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30795 23 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-5721
Mailing Address - Country:US
Mailing Address - Phone:586-421-1740
Mailing Address - Fax:586-421-1744
Practice Address - Street 1:30795 23 MILE RD
Practice Address - Street 2:#202
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047
Practice Address - Country:US
Practice Address - Phone:586-421-1740
Practice Address - Fax:586-421-1744
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAV071876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI137758OtherCARE CHOICES
MI147806OtherGLHP
MI16838OtherMCARE
MI350F314450OtherBCBS OF MICHIGAN
MIH93875OtherHAP
MIP34014FOtherBCN
MI4676860Medicaid
MI7703494OtherAETNA
MI137758OtherCARE CHOICES